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. 2015 Jan;98(1):34-40.
doi: 10.1016/j.pec.2014.10.002. Epub 2014 Oct 22.

Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling

Rebekah J Walker  1 , Mulugeta Gebregziabher  2 , Bonnie Martin-Harris  3 , Leonard E Egede  4
Affiliations

Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling

Rebekah J Walker et al. Patient Educ Couns. 2015 Jan.

Abstract

Objective: To develop and test latent variables of the social determinants of health that influence diabetes self-care.

Methods: 615 adults with type 2 diabetes were recruited from two adult primary care clinics in the southeastern United States. Confirmatory factor analyses (CFA) identified the latent factors underlying socioeconomic determinants, psychosocial determinants, and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling (SEM) investigated the relationship between determinants and self-care.

Results: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support and social status. The initial model (chi2(254) = 388.04, p < 0.001, RMSEA = 0.03, CFI = 0.98) showed that lower psychological distress (r = -0.13, p = 0.019), higher social support (r = 0.15, p = 0.008), and higher self-efficacy (r = 0.47, p < 0.001) were significantly related to diabetes self-care. Social status was not significantly related to self-care (r = 0.003, p = 0.952). In the trimmed model (chi2(189) = 211.40, p = 0.126, RMSEA = 0.01, CFI = 0.99) lower psychological distress (r = -0.13, p = 0.016), higher social support (r = 0.15, p = 0.007), and higher self-efficacy (r = 0.47, p < 0.001) remained significantly related to diabetes self-care.

Conclusion: Based on theoretical relationships, three latent factors that measure social determinants of health (psychological distress, social support and self-efficacy) are strongly associated with diabetes self-care.

Practice implications: This suggests that social determinants should be taken into account when developing patient self-care goals.

Keywords: Diabetes; Psychosocial factors; Self-care; Social determinants; Socioeconomic.

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Figures

Figure 1
Figure 1
Confirmatory Factor Analysis of Diabetes Self Care Behaviors Measurement Model. Note: Overall model fit chi2(8, n=604)=9.94, p=0.2692, CFI=0.99, RMSEA=0.02 (90% CI:0.00, 0.05). All factor loadings significant at p<0.001.
Figure 2
Figure 2
Initial Social Determinants of Self-Care model. Note: Coefficients are standardized path coefficients. Overall model fit chi2 (254, n=615)=388.04, p<0.001, RMSEA=0.03 (90% CI:0.02,0.04), CFI=0.98. All factor loadings significant at p<0.001. For paths *p<0.01, **p<0.001.
Figure 3
Figure 3
Final Social Determinants of Self-Care model (Trimmed). Note: Coefficients are standardized path coefficients. Overall model fit chi2(189, n=615)=211.40, p=0.126, RMSEA=0.01 (90% CI:0.00,0.02), CFI=0.99. All factor loadings significant at p<0.001. For paths *p<0.01, **p<0.001.
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